title: Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines: a 24-institution study. Institutions of the Multicenter Study of Perioperative Ischemia Research Group.
abstract: BACKGROUND
  An estimated 20% of allogeneic blood transfusions in the United States are associated with cardiac surgery. National consensus guidelines for allogeneic transfusion associated with coronary artery bypass graft (CABG) surgery have existed since the mid- to late 1980s. The appropriateness and uniformity of institutional transfusion practice was questioned in 1991. An assessment of current transfusion practice patterns was warranted.
  
  
  METHODS
  The Multicenter Study of Perioperative Ischemia database consists of comprehensive information on the course of surgery in 2,417 randomly selected patients undergoing CABG surgery at 24 institutions. A subset of 713 patients expected to be at low risk for transfusion was examined. Allogeneic transfusion was evaluated across institutions. Institution as an independent risk factor for allogeneic transfusion was determined in a multivariable model.
  
  
  RESULTS
  Significant variability in institutional transfusion practice was observed for allogeneic packed red blood cells (PRBCs) (27-92% of patients transfused) and hemostatic blood components (platelets, 0-36%; fresh frozen plasma, 0-36%; cryoprecipitate, 0-17% of patients transfused). For patients at institutions with liberal rather than conservative transfusion practice, the odds ratio for transfusion of PRBCs was 6.5 (95% confidence interval [CI], 3.8-10.8) and for hemostatic blood components it was 2 (95% CI, 1.2-3.4). Institution was an independent determinant of transfusion risk associated with CABG surgery.
  
  
  CONCLUSIONS
  Institutions continue to vary significantly in their transfusion practices for CABG surgery. A more rational and conservative approach to transfusion practice at the institutional level is warranted.
authors.affiliation: Stanford University School of Medicine, California 94305, USA. stover@leland.stanford.edu
authors.forename: E P
authors.initials: EP
authors.lastname: Stover
authors.forename: L C
authors.initials: LC
authors.lastname: Siegel
authors.forename: R
authors.initials: R
authors.lastname: Parks
authors.forename: J
authors.initials: J
authors.lastname: Levin
authors.forename: S C
authors.initials: SC
authors.lastname: Body
authors.forename: R
authors.initials: R
authors.lastname: Maddi
authors.forename: M N
authors.initials: MN
authors.lastname: D'Ambra
authors.forename: D T
authors.initials: DT
authors.lastname: Mangano
authors.forename: B D
authors.initials: BD
authors.lastname: Spiess
mesh_terms: D016913:Blood Component Transfusion / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass; D016208:Databases, Factual; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007431:Intraoperative Complications; D017202:Myocardial Ischemia; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011897:Random Allocation; D012307:Risk Factors; D014481:United States